When Ryan Murphy released his latest TV production Ratched, narratives about psychiatric institutions became a hot topic again thanks to its a star-studded cast and glossy 1940s design. Set around the same as that One Flew Over the Cuckoo’s Nest sequel on an island many miles away, another recent drama offers its own take on mental health institutions. Directed by Leticia Tonos, A State of Madness depicts a psychiatric hospital in the Dominican Republic. And though it may not be as successful as its thematic cousins, it draws attention to a pivotal time in the country’s history.
Indeed, the story takes place during the time of Rafael Trujillo, a dictator who ruled with an iron fist. Like the government’s rule, the Nigüa Psychiatric Hospital imposes a similarly oppressive system, using primitive techniques for treatment. When a group of mental patients escape and intrude on a high society party, the institution is placed under scrutiny. In response, a man named Dr. Antonio Zaglul is appointed as the new director. His arrival instills a new approach guided by compassion and science. But the hospital isn’t immune to the influence of external politics.
Tonos shows off her directing chops from the start, staging a escape scene that capitalizes on the nighttime glow to signal the film’s neo-noir intensions. As patients crash the party, she also showcases her absurdist sense of humor as they playfully engage with the party’s guests. When we return the hospital, there’s also a foreboding atmosphere created by the flickering lights and the patients’ agonized sounds and zombie-like body language.
The screenplay struggles to keep up with the stylish direction however. While the recreation of the period through the decor and costumes instills a strong sense of the time period, those unfamiliar with the political context may feel lost. And though Trujillo’s regimem is referenced throughout, the plot doesn’t clearly make the connection between his policies and the hospital.
Luis José Germán’s performance as Dr. Zaglul brings a tender humanity to his interactions with the various patients, whether they are overcome by manic fits or more quietly discussing their treatment. And the supporting cast are equally adept at embodying their roles. As written, however, these encounters hardly feel fresh to the genre and are structured too episodically to make an ultimate impact. Eventually, a murder mystery arrives to add some intrigue to the story but it feels like a little too late. A State of Madness is worth commending for its attention to the period details, but it’s story leaves you wanting.